Individual
NATACHA DESTRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
227 MEDICAL WAY, RIVERDALE, GA 30274
(470) 298-7236
Mailing address
10019 REISTERSTOWN RD FL 3, OWINGS MILLS, MD 21117-3902
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LPN080370
GA
Other
Enumeration date
08/24/2021
Last updated
08/24/2021
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